Only modest changes in body composition have been reported in many of the studies that have investigated the effects of exercise on obesity. It is plausible that activity of higher intensity or longer duration could have resulted in a more dramatic fat loss. Unfortunately, obese people may not benefit from physical activity as readily as less obese individuals since they may be limited in their ability to exercise vigorously for substantial duration. In addition, physical activity accounts for only a fraction of the daily caloric expenditure for the majority of the obese population. The implementation of an exercise program will raise this fraction only slightly. On the other hand, once an adequate exercise program is followed, less fit individuals, such as the mildly obese, can improve their fitness levels relatively faster than individuals of greater initial fitness.
Obese individuals must consider potential problems in engaging in an exercise program. They may include, balance anxiety, muscular weakness, pulmonary hypertension, low back pain, movement restriction, orthopedic problems, ionic disbalance, poor circulation (diabetics), excessive perspiration, flush skin, hypenea, dyspnea, tachycardia, arterial hypertension, body heat build up, ketonuria, chafing, muscle cramps, orthostatic hypotension, and heavy strain on joints. The exercise professional may address these obstacles dependent on their clients circumstances. Other factors to be considered include the duration of obesity, maturation, motivation, mental state, exercise history, eating patterns, and socialization. Program support may include medical evaluation, nutritional counseling, behavioral counseling, and exercise instruction and consultation.
Obese individuals initiating a fat loss regimen can be counseled on various techniques designed to increase program adherence. These may include the implementation of support groups, personal contracts, exercise and diet journals, and regular fitness tests. The over enthusiastic client may need to be encouraged to progress slowly and to yield to undo discomfort. The obese exercise participant may also explore the possibilities of exercise partners of similar fitness level, group versus individual exercise, structures for self competition, and diversions such as reading, listening to music, or watching television while exercising. Social support from family, friends, employees, and social groups should not be disregarded. Lifestyle changes throughout the day may be encouraged to further assist in energy expenditure. They may include, parking a distance from their destination, less reliance on vehicular transportation, using stairs instead of the elevator, walking around town to perform local errands.
Exercise can play a very important role in the treatment of obesity when combined with a multifaceted approach as discussed in this paper. Physical activity can improve health, decrease the loss of muscle mass, increase functional strength, and greatly improve the likelihood of achieving successful weight maintenance. Relatively few studies have been conducted with severe or morbid obese subjects. More research is needed in this area.
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